Bilateral Open Adductor Longus Tenotomy Is Associated With Predictable Return to Play in Professional Soccer Players:...

Dynamic pubic osteopathy is a clinical diagnosis characterized by chronic localized pain at the pubic insertion of the adductor longus that can limit high-level athletic performance in professional soccer players. Although open adductor longus tenotomy has been used for decades in selected athletes, little is known about return-to-play (RTP) timelines and outcomes in professional soccer players undergoing modern bilateral open release.

We asked: (1) How long after bilateral open adductor longus tenotomy did professional soccer players return to unrestricted match participation? (2) What proportion returned to their preinjury competitive level? (3) Was player age associated with RTP duration? (4) What complications and reoperations occurred after surgery?

We performed a retrospective case series of 100 professional men's soccer players (Tegner activity level 9 to 10) who underwent bilateral open adductor longus tenotomy between 2011 and 2024. All patients were diagnosed clinically with dynamic pubic osteopathy based on localized pubic insertion pain reproduced with resisted adduction. Radiographs were used to exclude fractures, stress fractures, tumors, or avulsion injuries. MRI was performed to evaluate associated findings such as bone edema or degenerative changes of the pubic symphysis; however, imaging findings were frequently within normal limits or reflected chronic adaptive changes unrelated to current symptoms. All athletes had persistent symptoms despite structured nonoperative management including flexibility work and training-load modification. During the study period, these 100 players represented all surgically treated patients with this diagnosis at our institution, and no patients were lost to follow-up. The primary endpoint was days from surgery to medical clearance for unrestricted match play. Secondary endpoints included return to preinjury level, complications, and reoperations. Major complications were defined as events that substantially altered recovery (such as infection, clinically important bleeding, or thromboembolic events). Correlation between age and RTP was assessed using Spearman coefficient.

All 100 players returned to competitive soccer. The median (IQR) RTP time was 87 days (62 to 128). Ninety-eight percent (98 of 100) resumed competition at their preinjury level; one returned at a lower competitive level, and one retired for reasons unrelated to surgery. Age was not associated with time to RTP (ρ = 0.04; p = 0.84). Two percent (2 of 100) underwent revision surgery. No major complications occurred.

In this study of professional men's soccer players with clinically diagnosed dynamic pubic osteopathy, bilateral open adductor longus tenotomy was associated with return to unrestricted match play at a median of 87 days, with 98% resuming their preinjury competitive level. No major complications occurred, and 2% of players underwent revision surgery. Within the limits of this retrospective design, the procedure may be considered a surgical option in high-performance athletes with persistent symptoms despite structured nonoperative management.

Level IV, therapeutic study.